ICU as a cardiopulmonary area of physiotherapy?

Looking back on the almost finished 5 weeks in ICU I have thought about the skills we have learnt and have pondered how this relates to the whole wide world of physiotherapy! ICU physio's definitely have a huge role to play which is pretty cool. Luckily the four of us have been able to practice oodles of manual hyperinflation, suctioning and the occasional thoracic expansion exercise with our patients. Moreso we have learnt heaps about other systems - renal, cardiovasc, neuro, musculo,gut, etc. It's funny to think that there are some people who dont get to suction at all during their pracs, or never see an ICP monitor, coz we are pretty used to these kind of things now... but on the other hand there is a lot we haven't been able to practise cardiopulmonry-wise eg. the pulmonary rehab side of things. Being a bit of a hot topic me thinks that the pulmonary rehab side of things will be examined at the end of the year, and will also be extremely relevant in the hospital sector if we choose to work in it....and so it's kind of scary thinking that ICU prac students could potentially graduate without ever conducting a 6MWT! We have done a few more 'rehabby' case studies to make up for this, but is this sufficient for the big wide cardiopulmonary rehab world?! Have a good break ya'll!xoxo

Clingy patients

I am currently at Curtin Clinic and I have found a somewhat common theme with patients referred from Bentley Hospital. They come in with a referral for one condition then once this has been treated for some time would like a new problem to be treated. In such a case it is required that they go back to their doctor and receive a new referral or they must pay the full fee. This is not too hard to explain to the patient if they are complaining of pain in an opposing peripheral joint with an unrelated cause. However, if it is a series of related problems to the initial presentation it begins to get tricky. It also gets silly in Rx sessions... so what pain is worst today? What do you feel needs Rx today...etc. ha ha
For example, a patient I have been treating referred for L epicondylagia. Who then developed it in the R F/A also... fair enough. Who then released both shoulders were getting painful (over used UT's, deltoid, pecs) fair enough, related to elbow dysfunction. Who then was getting neck pain... yeah ok relationship here also...
However, this is a patient who does not do her HEP and does not allow herself to rest as she is a single parent with two jobs that require her to repetitively use her UL's and lazy kids who refuse to help her with domestic chores that agg her pain (cleaning, washing, vacuuming, mopping, wiping surfaces... the list cont.s) She is also stubborn in the sense that she does not do anything suggested to ease her pain besides applying heat at night and continues to over do it with, ADL's and gym exs (only focus on her biceps/ triceps/ lats/ PECS) which merely increase the tightness of her tight muscles and do not focus on control/ endurance and the weak mms (LT's, SA). This is despite educating her of what physiotherapy deems best for her condition. Also talked about how it is her responsibility to complete an effective HEP to reduce her pain. The patients response is not enough time, need money, not enough help so pushes through the pain.
Her aim with physio when asked is to get some relief so she can cont to function in the way that she always does. She does not wish to D/C soon as her pain is still high when exacerbated and she needs a Rx...
So my point is, it just does not seem fair. I feel that it is an abuse of the system on her part as she does not pay for the Rx and expects to be continually treated without actively participating in her Rx. Do I write a letter to her Dr explaining her plateauing progress. Do I persist to tell her she must D/C soon as she is "wasting my time" if she doesn't try to Mx gaining with a HEP (for lack of figuring a nicer way to say it at this moment in time). I dunno suggestions, what you think? Thanks

Dreaded handovers

Hey guys,

Anyone who’s done a musculo prac probably knows my frustration…. Its final week and its time to handover all of our patients to the new students coming during the mid semester break. My appointments this week filled up quite quickly as I wanted to see all my patients one more time before ‘handing them over’. We have no patients on Friday, the whole day is set aside for paperwork, but I don’t particularly want to be there until 10pm Friday night trying to get all the handovers/doctors letters finished! When I first started this prac I’d been warned of the stress it puts on you do leave them all to the last minute and had planned to do handovers for each pt as soon as I saw them for the last time. Unfortunately, things didn’t quite work out that way and I still have about 20 handovers/doctors letters to write. We have the day off today (we’ve done full days the last 2 Thursdays to make up for it) so I’m about to go into the clinic and get all of my handovers done so there’s only my Wed/Thurs pts to finish on Friday. So its worked out quite well for me having the day off today, but I just wanted to give everyone some advice (that you’ve probably already been told, I just want to REALLY reinforce it)….. Try to do your handovers as you see each pt for the last time, half hour overtime each day is definitely better than completely stressing yourself out on the last day or spending your day off at the clinic!

Have fun during the break guys, we deserve it, and stay safe xox

A bit 'On the Nose'

Hey guys,
Sorry for lateness technology let me down last night and I couldn't post my blog as the internet gods were unhappy with me.
My post this week comes again from the nature of my placement in that it involves a lot of visits to clients homes. I had one particular visit this week which I don't think I could ever forget, and not in a good way. This house was smelly. Due to the 'professional' nature of this forum I can't use appropriate words to emphasise just how smelly, but it was unbelievable. I have never encountered anything like it. The visit was for a multidiscplinary family meeting, and I walked into the kitchen to find an OT, a PT and a Speechie all perched on the edge of their chairs looking uncomfortable. I looked down at my own chair and realised why. It was FILTHY. I'm not exaggerating when I say it had never been cleaned in its entire life as a chair. I looked around and the rest of the kitchen was in the same state. There was grime smeared down every cupboard, and mould everywhere. There was a mound of something next to my seat which looked like it may have once been bread crusts.
I joined suit and perched on the edge of the filth, clutching my handbag. Throughout the hour I was at the house, I gagged at least 5 or 6 times, each time doing my best to disguise it as some kind of coughing fit. I felt ILL. I felt as though I was contracting some kind of deadly disease, or at least a chest infection, just by breathing inside this house.
I left the house bewildered and nauseous, but also outraged - Why should I be subjected to this? When does a house become disgusting enough that we can refuse a home visit and insist the family come to the centre for treatment? And more importantly, when does a house become filthy enough that the owners can be forced to clean it due to health risk to their children?

A few tricks...

Alright, here I am on my final week in hands at RPH and I am happy to say that I am still absolutely loving it! ON this prac I have seen lots of different upper limb injuries, but one I wanted to discuss, is the traditional distal radius fracture. This is so common, and I can't really narrow it down to a specific age or gender... I've had everyone from a 60yr old man to a 21 yr old woman present with it. The thing that surprises me most about this injury is the amount of time it takes to recover!! Most of the pt's I have seen have made huge advances in range during the first six weeks but then progress seems to slow for a few weeks before the next period of improvement. I guess in my inexperience I expected a full recovery in 8-12 weeks, but to my surprise, on talking to my supervisor, it can take 18-24 months to regain full strength back!! WOW! Another surprise is the variability in progression that exists between pt's... Despite similar treatment, one pt may progress beautifully - within six weeks having regained full pain-free ROM, whereas another may be stuck with a stiff and painful wrist for more than eight weeks following ORIF and Early AROM ex's. This can be a little disheartening for both me and the pt, but it is comforting to know that full recovery can take many months. One technique which I have found incredibly effective is wrist mobs!! Usually after 6-8 weeks, the old PA and AP mobs in EOR extension and flexion respectively become my best friend in regaining ROM. Another technique I was shown, which we weren't taught at uni is like a SNAG but in the wrist where you stabilise the ulna and glide the radius as the pt actively supinates the wrist... a real beauty to improve supination range and therefore improve function. HAs anyone else found mobs particularly useful in treatment or picked up any little trick they'd like to share??

STUDENT PHYSIO

Hey guys, last week! Woo Hoo! Two weeks ago, i was patiently waiting for my patient to arrive when my supervisor warned me that my next patient may be a bit of a dosey (well she didn't actually say that but you get the point). Anyway he arrived and the first thing he said to me was "I have 45mins!" Wow, i thought even if i am deemed to be competent on this prac. my initial assessments should take me 1 hr, what the hell am i going to achieve in 45mins. My supervisor and the receptionist told me that they had told the patient when he made the appointment that it would take minimum of an hour so why would he rock up and state that he had less time than that! Anyway, we got started and i completed the subjective in record time and as i was about to leave the cubicle and talk to my supervisor he inquired if "i was aware of the time?" I stated "yes". Unfortunately his case was complicated and therefore my objective consisted of various things which took 25mins. As i finished the last PAIVM he got off the bed and said he had to go. I was shocked, becuase i hadn't even treated him, let alone diagnosed anything yet. I suggested to him that myabe a student clinic didn't suit his time contraints as, being a student i was unable to take short cuts. He responded by saying he worked here so it was convinient. I began to wonder, how could it be convinient if every week he could only spare 45mins, therefore restricing the treatment opitions available, as well as making it difficult to correctly diagnose. And how could he be satisfied if i hadn't even began to treat hom or told him what his problem was. Oh well i thought if you wanna come back next week, thats fine with me, it actually was a very interesting case.

One week later, im waiting for my patient to arrive, knowing i only have 45mins, so i had carefully planned, exactly what i was going to do.....and he DOESN'T SHOW!

I guess im getting a little frustrated at patients taking us for a ride, just becuase we are students. In my opinion we actually do a fantastic job and although we don't have every patient in and out in 20mins we are very thourough and usually get pretty good results. Just wondering if anyone else is feeling this way too.

Enjoy your last week and best of luck for your final assessments.

our job?

'excuse me, I would like to go to toilet' ... I've been hearing this very frequently in my ward especially in the morning when all nurses are busy showering and dressing patients where there is no one around that can bring them to toilets. And I have done it a few occasions, I did walk patients to toilet even though they are not under my care and waited there for 5-1o mins until they are done and walked them back and the whole process taking 20 minutes on average. My supervisor picked up on this and told me not to feel obligated to do this as it is not part of our job which I do agree with but seeing patients who are supposingly continent but who became incontinent due to this reason is also unacceptable. Therefore just wondering if anyone had similar experience and best solution if possible?

What to do...

Hey guys, as you know I’m still on my cardio placement at SCGH and last week I encountered an ethical problem that I’m hoping someone can help me with. I have been treating a 65 yr old man with pneumonia who is currently stable from a respiratory point of view however his condition is complicated due to the fact that he is suffering from alcohol withdrawal. During my last treatment session with this pt about 4 or 5 of his close family and friends came to visit him. I introduced myself to the group and invited them to stay for the session as I thought that this would give the pt more motivation to go for a walk, which he had been resisting! However this turned out to be a bad idea as the family were understandably very anxious and eager to find out about how the pt was doing and so bombarded me with questions that really weren’t physio related. Questions included what was the plan for the pt, when he would be able to go home, would he need to continue taking his medication at home and would he need oxygen at home etc. Although after reading the pts notes and liaising with the pts doctors on a regular basis I could have actually answered many of these questions I really didn’t know if it was my place to do so. I felt like I should give the family some relief so I tried to answer some of their questions, however I stopped myself after a while and told them that they should really speak to the pts doctor regarding his medical status. My question is, is it wrong to give information on medical issues as, as physios we are not actually qualified to do this even when you are sure what you are saying is correct and that the advice you give will help to make the pts family feel less worried?

Hard news

Hey guys,

I have a few cases at the moment on my prac where I might have to face telling my pts some hard news. One is a girl about our age who my supervisor and I suspect has an ACL tear (partial or rupture) that she sustained about 2 months ago. Her clinical picture does not perfectly fit the “classic” ACL presentation and it may just be a slight ACL strain with assoc meniscal injury or chondral/articular cartilage bruise. I explained to her that there were a few possible diagnoses (including ACL tear) and we are currently trying some Rx with the hope that she improves so we can exclude ACL tear.

My other patient has come in with knee pain after an MBA but he has REALLY hypermobile joints (McMurray’s on the unaffected and affected side causes tib-fem subluxation with internal and external rotation of the tibia!!!). Because of his appearance and hypermobility, my supervisor thinks he may have an undiagnosed medical condition that can be quite serious.

Just wondering if anyone has any hints as to how I can approach telling a promising young athlete that I think she may need a knee reconstruction (or at least need further investigations as this is what I suspect) and how do I tell my hypermobile pt that he should visit his doctor regarding his health when he’s just got a sore knee!!

xox

Performance anxiety

Hi All... So we have all experienced it at some stage... Performance damanging anxiety when someone is watching and grading you. During my first prac it still felt like the good old OSPE days when you get overly shaken up from the experience so miss out curcial things from your Ax, find it harder to multi task (observe all joints at once, perform a correct technique and take in findings as well as talk to a patient n write findings down e.t.c). Overall you appear less confident/ competent and find it harder to establish patient rapour.... EEk dissapointment :)
So it is much less stressfull for us all now currently finishing prac 3... However, I do now find it sometimes necessary to explain my learning style to my supervisor so I can maximise my learning and performance. I also ask how the Ax is conducted and if I feel the need, ask if it can be a bit adapted :) For example, to interrupt as little as possible and ask later if applicable so I dont loose flow of the Rx session. This is also so I can more easily forget that they are watching ha, ha... So does anyone else have ways in which they try to adapt their Ax situation or tricks and handy hints up their sleeve to perform well during Ax's...

Thorough or poor time management?

This is something I guess everyone struggles with, and it's all about finding a BALANCE, but just how do we find that perfect union between being effective without being time consuming?

At my last prac in musculo outpt's I was criticised for poor time management skills as I was initially taking between 1hr to 1.5hrs for an initial consultation. Now it seems that the notion of time management is fairly variable across facilities. Having talked to various people at different facilities, 1-1.5 hrs can range from being deemed acceptable to highly unacceptable. Obviously as you build clinical experience it is easier to hone assessments in to become more time efficient. I guess my question is, would I still be able to effectively treat my pt if I did only half of my assessment? I think the answer is no! I would probably be much more inclined to jump to assumptions about a pt, which could often be wrong, as I don't have the clinical experience to make appropriate assumptions without actually assessing. And as students, we are keen to not miss anything out in case our supervisor asks us about it, so hence comes the difficulty to treat effectively in a minimal amount of time. Does anyone have any advice on how they manage this often stressful predicament??

HYDRO

Hey guys, hope you are still enjoying your placements.
Last week i had the opportunity to attend a hydro class with one of my patients. The pool was lovely and warm but to my concern for the life of me i could not remember any exercises that we had been taught in 2nd year (i think) from those hydro class that we went to. I rememeber something vaguely about using floats and weights and the water acts as resistance but nothing specific abuot exercises. It was quite intense for the whole hour trying to rack my brain and be imaginative, in order to come up with a progression and variety of exercises. Just wondering if anyone rememebers if we ever got a hand out or if any one has any bright ideas about exercises to perform in the pool. THANKS in advance, a response would be greatly appreciated.

Tracheostomies

Jjust wanted to tell you all about last Friday when I got to see a trachy being done in ICU. Once patients have been with us for more than about a week, the medical team start to consider trachy's as a more long-term way of keeping airways patent, etc. So... they made a transverse incision halfway between the cricoid cartilage and sternal notch, popped in a guiding wire, syringe for ETCO2 monitoring and then what they called a rhino horn to dilate the incision before putting in the cuff/tube etc.... It was so interesting to watch and now I have a much better understanding of trachys (it also made me feel quite queasy though which was so embarassing. Any tips for vaso vagal reactions?!). I wonder what these patients think when they come off their sedatives and wake up with a trachy...do you think they would be unbearably uncomfortable? Must be a very strange feeling. Has anyone else seen any more interesting surgical procedures; and did they find them helpful to understand more about something?

Parents in Denial

As the title suggests, one of the biggest problems I've come across during this prac is parents in denial of their childs disability. These parents are convinced their child is 'normal' despite the fact they're not talking, standing or walking by 2 years of age.
This is particularly negative in one family, where the father blatantly refuses to sign to his child. The child is significantly delayed and one of his only methods of communication is to use keyword signing. The father will not learn the sign language, and also will not 'allow' his wife to use it in his presence. How can we get through to parents like this who are so determined to pretend their child is 'normal' that they are causing further detriment to their development??

Language barrier

hi everyone, hope pracs are going well for all. The highlight of my week would be a patient in my ward who speaks 3 different languages apart from English... it was hard enough to obtain subjective history where in the end I had to involve the family and OT to help me complete it. However, it is unrealistic to have an interpretor for every treatment session, and patients will be unwilling to see you if all their family times are taken for physio sessions. Most of the time I felt like I was talking to myself and pt just nods with anything I say and an awkward silence follows as pt does not do anything after the nod.
I am just wondering if anyone has any suggestions regarding to this pt's management as she does seems like a good candidate for rehabilitation and would benefit alot from PT point of view.

Hey everyone, Im on my prac at SCGH and every Wednesday afternoon we have a staff continuing education session. This involves either one of the Physio’s who work in the hospital or guest speaker giving a talk on a topic of interest. Last week one of the Physio’s who works in the musculoskeletal outpatient field gave a very interesting and informative talk on pts with chronic pain so I thought I would share with you all some of the things she had to say. Basically she made it very clear that chronic pain pts are very difficult to treat as they have so many other issues contributing to their problem and therefore we should never attempt to deal with these pts on our own. Successful treatment of these pts usually requires input from the multidisciplinary team as their pain is so crippling all aspects of their lives are affected by it (work, relationships, family dynamics ect.). The physio explained that it is important to appreciate that although the pt may not demonstrate any known pathological condition their pain is real and we need to acknowledge it, however it is crucial that we as physio’s do not reinforce the pts passive attitude to their situation. That is we need to encourage the pt to be as active as possible and to try to be independent in every way that they can. The physio pointed out that this can be a difficult task in the inpatient hospital setting as you just don’t have the time or specific skills to achieve this. The fact that all the other members of the health care team may not be sending the same message to the pt can also compromise the situation. The physio therefore stressed that these difficult pts need to be identified early and if possible referred to a physio with a better understanding of chronic pain and a good knowledge of the techniques required to treat this clinical gp.

This physio runs an outpatient 5 week program at charlies for pts with chronic pain that includes exercises to treat the pts impairments and hopefully improve their function as well as lectures that aim to change the pts attitude towards their condition. The program is very much focused on trying to get the pt to take a more active role in trying to fix the problem rather than always opting for the ‘hands on treatment’ or the ‘quick-fix surgery.’ For the program to be successful the pt has to be motivated and committed to making changes to their situation, unfortunately many of the pts fail to put in the effort and drop out of the group before the end of the 5 weeks.

After hearing this talk I wondered are we as fourth yr physio students really equipped to deal with these pts? I personally don’t feel very confident that I would be able to manage a pt with chronic pain effectively and think that perhaps some more information and practical application focused on this clinical gp would have been very helpful throughout the course.

Too many supervisors too little time!

We have about 6 physios who work on rotation in ICU (3 nights on, 3 days on, 3 days off) which means that we are constantly being swapped around between supervisors and never spend more than a couple of days with anyone at once. I am struggling to figure out the different standards between each in terms of note-writing, etc and its beginning to frustrate me a lot. One took me aside today and told me that I need to become more independent with my treatments and another told me I couldn't do any interventions until she was there to assist me! We have our midplace assessments this week and the lady who is doing mine has only spent about 4 days out of the 12 so far with me and so i feel like it's not an accurate represnetation of how I am day-to-day on clinics (I guess that could work either in my favour or against it!). Is anyone else in a clinic where they have lots of supervisors, or have any tips? :)

Where am I?

Hey guys, this is a bit of a strange one but here goes. As some of you may know, I have the tendency to get a little lost. As soon as I leave my comfort zone (which pretty much extends from home as far as uni, Cottesloe or Scarborough) my sense of direction goes out the window.

This has proven a little problematic during my current prac. I'm based in Joondalup in an office, and the placement consists of driving out to various homes or schools and treating little kiddies out there. I can get to Joondy ok (even I find it difficult to get lost on the freeway) but I often need to drive out to suburbs I have never heard of in a snazzy little government car ON MY OWN!

I do own a UBD and I am capable of reading it, however in unfamiliar territory I am known to take a slightly wrong turn or go a little too far and miss a turn off. These are fatal mistakes in more remote suburbs as lovely roads such as the Reid highway do not allow for mistakes nor do they have available areas to pull over and read a map. So such is a skill I am mastering - reading a UBD sitting precariously on my steering wheel while driving 100 km/h. This is DANGEROUS.

The most frustrating part of this is half the time when I finally get to the house the family are:
a) not home
b) the kid is sick or
c) they have forgotten you were meant to be coming (despite you confirming the appointment that morning) and are about to go somewhere!
Talk about frustrating...

So my question is, do I fork out $300 for a global positioning system that tells me in a friendly recorded computer voice step by step instructions on how to reach my destination? Or should I sticky tape maps to my windscreen so I can read them while "keeping an eye" on the road?
Any other suggestions?


dani xx

Low back pain...

I’m doing my musculoskeletal outpatients prac at Curtin and I have a patient who has presented pre-low back pain - he would like physio to prevent him from experiencing the low back pain he has had in the past. Seemed fairly straight forward, we’d go through TA/core stability, bracing, lifting techniques, etc… That’s what I thought until we started going through the history of his low back pain. He had one previous acute episode of low back pain while living in Melbourne and was told he had “slipped a disc” by a treating physio. He explained to me that another physio told him it was his tight leg muscles that were “throwing his back out” and he’d had physio in the past to loosen his muscles and back pain was eased and prevented.

After assessing the length of his major LL muscles I found that his had quite good flexibility for a 30 year old man. The length of his hamstrings was increased using hold-relax and rather than focus on the LL muscles of normal length I chose to work on improving his core stability, progressing his TA/MF exercises, glute max activation and strength, posture/ergonomic advice as well as maintaining the length of his muscles with a stretching program.

My problem came when trying to explain to my patient why we were going a different direction with his treatment to his previous physio (ie. core stability instead of LL massage). He was happy with his treatment and HEP and he also stated that he was impressed with the thoroughness (if that’s a word) of his assessment at CPC and that he felt his previous physios just rushed his assessment in order to get him in and out of the door faster. I explained to him that based on my assessment his muscle length was improving and we now needed to focus on his lumbo-pelvic control and strength.

I was able to please my patient with my rationale for treatment but it got me thinking what would I do if I was forced to contradict another’s opinion? Has anyone been put in a situation like this and how did you manage to persuade your patient that your way is the right way (or the right way for now)?

Family Flood

Hi guys, I have really enjoyed reading all your blogs and from the sounds of it we are (most of the time) enjoying our pracs. They did always say this year would be the best. At first i thought this blog thing was going to be stupid but to my suprise, i look forward to reading everyone's post each week.

GREAT NEWS, the musculo prac is do-able and enjoyable! During my first week on this prac, i thought oh my gosh, i will never survive 5 weeks of this constant stress of note writing, time management, and total lack of confidence in my ability. Just a general incompetancy alround. However, during the last week i actually enjoyed seeing my patients and the improvement that (most of them) had made, and did you know that tx PPIVM's exist? I'm getting side tracked but I just thought I'd let those of you who haven't done your musculo prac that no matter how hard that 1st week feels it does get better (with a little effort from you).

My blog this week involves FAMILIES. I just read Kayla's blog and she was talking about how great it was to be able to communicate with the family and the patient to further improve the pt's outcome, and rightly so but this week i have encountered something at the other end of the scale. During my 2nd Rx session with my pt this week, someone yelled out "Who's in with ______, his family want to know where he is." So i ofcourse said "In here", expecting them to say "Ok, well we will just wait out in reception" but NO they just barged into the cubical, the pt's wife, daughter and mother. I was so shocked and boy was it crowded, 5 ppl in those tiny cubilce's is alot. They didn't ask me if it was okay they just stood and stared at me. I attempted to continue with the Rx session but I didn't get a chance. They started firing questions at me. I should have said earlier that the pt himself is so nice, very eagar to continue with Rx, and very co-operative, however this could not be said of his wife. She just blasted me with all these questions about his recovery and why he wasn't fixed already etc. Now, I understand the whole "concerned wife thing" but the pt had already been told and understood everything about his recovery and the lenght of time it would take to return to pre-accident state, so I was quite taken back by this onslaught. I had to get out of there! So we ALL went out into the gym area to do some exercises.

As the pt performed the exercises the wife would state that he couldn't do that one b/c he was in "so much pain". But, when I asked the pt himself during the Rx session he said that it was fine. By this point I was getting a little frustrated, so i thought i would involve the wife into the pt's HEP incase she felt left out or something but NO when i asked her if she could do this for her husband she just totally blew me off. By now, i had nearly had enough. I felt like i was the "bad guy" who obviously had done 'nothing' to help the pt. We walked out to reception, and again the wife was firing at me all these questions about the consultant's appointment, of which i had no idea about, and attempted to explain. This was not good enough and i then had to go and get my supervisor, who managed to answer her questions. I felt like as a student, the pt's family gave me no respect and i definately had no control.

My question is: "Can a family be detremental towards a pt's recovery?" and will i ever as a student be brave enough to say "Excuse me do you mind waiting outside during the Rx session and i will answer any questions afterwards"? I feel like if i was a REAL PT or in my own practice i would have had no concerns with saying that, but being a student and representing Curtin, it just felt so awkward and intimidating.

Let me know what you think and if you have any good ideas of how to approach the FAMILY FLOOD!

Hope you all have a fantastic week!
Suanne

An 18 yr old boy with down-syndrome was admitted to the respiratory ward at SCGH after spending a week in ICU with a severe chest infection. The pt had an endo-tracheal tube put in and as a result was unable to verbally communicate. This combined with the fact that he was mentally delayed (intellectual capacity of a 6 yr old) made it extremely difficult to treat the pt. After a few treatment sessions I began to develop a non-verbal form of communication with the pt. I found that by speaking clearly and slowly the pt was able to lip read and gained a general understanding of what I was saying. However I did find it very difficult to interpret what it was that the pt was trying to express to me in return as he tended to look down and turn his face away when mouthing the words, making it difficult to see what he was saying. I tried to overcome the problem by continually repeating my questions/instructions and asking the pt to look up at me when responding. However I found that after a few attempts the pt started to get frustrated and would just ignore me making it very difficult to complete the treatment session. After two or three more unsuccessful treatment sessions, I was lucky enough to meet the pts family and through talking to them I learnt a lot more about the pt. They informed me of the pts likes and dislikes and I was able to use this information to help to motivate the pt making our future sessions more effective. From this experience I realised just how important communication with the pt is and how crucial it is to build good rapport with them and that sometimes in order to do this you need to put in a bit more effort and be persistent.

CCT vs FCE

I am sure many people had or are having this difficulty in clinics as in whom to listen to and whose advise to take on board when both of your tutors have different opinions on the same issue. Not to mention those who is having more than 2 supervisors in the same facility and I can definitely understand how hard that is.
Nevertheless, I do understand it is definitely more beneficial to have additional help and valuable advice from more experienced individuals and the more the better!! however, these advices can vary between individuals due to their personal experiences + knowledge (even though they both can lead to better outcome for the patients). And students are usually stucked in between.
I mean I do support the fact that CCT and FCE are equally important especially in a busy ward when FCE has a busy busy workload and is having 3-4 students at the same time. So my question is obliviously what to do when we face this situation? and obliviously some discussions will be needed and I reckon these are the best options. First is to approach our supervisor in more of a suggestion manner rather than a condemning manner such as 'because CCT/FCE said so' eliminating his/her advice without considering them. Second would be to discuss with both CCT and FCE at the same time. Does anyone have any better suggestion?
Sorry if I am not being too clear due to the long weekend...

Exhuastive brainwave activity

I found that as the weeks accumulate and each placement unfolds I am growing more and more in motivation to do more, see more and read more, yet lacking more and more in the energy to do so :)
As a result I am left feeling frustrated! Yes I will definitely do that reading tonight or yes I must revise this topic over the weekend...
I find there are a few plots that often unfold after these thoughts...

1. Brain fry
I get home and my brain cannot even string together a proper sentence and I opt to give my poor brain a rest

2. Shut down
I do the reading but it goes in one eye and out the other without touching my memory bank

3. Found flame
I was tired but I find a 2nd wind, I push on and do the reading/ plan and its great, woo hoo!! my mind ticks over with the revised or devised material... The 2nd wind persists... then I struggle to fall asleep til late and I wake up so tired that I find it hard to function at prac so the purpose of studying to perform well is redundant anyway.

Okay, well Im not that bad always but these plots are starting to become more frequent and its scaring me... Come on any secrets? how do you manage your revision time? and how do you conserve energy so you have enough for prac and after prac?